AFFIDAVIT OF PERSONAL PROPERTY, INCOME AND ASSETS Name and address of Applicant -------------------------------------------------------------------------------------------------Phone Numbers REAL ESTATE A) RESIDENTIAL

Address Owned 1) Address of property (Home, etc) 2) xxx B) PLANTATION / FARM LAND xx acres at xxxxxx Rs xxx lakhs Description: (Description of plantation/farmland) OTHER ASSETS A) FINANCIAL ACCOUNTS 1) Current and savings Bank Accounts (Account number Branch 2) ------------------------------3) Life Insurance B) VEHICLES Description Owned Present fair market value Rs xx lakhs Yes Rs xx lakhs Yes Present fair market value Rs xxxx lakhs Rs xx lakhs Yes Yes

Rs xxx lakhs

1) Car type - Mid size / full size (Car make ) C) JEWELRY, FURNITURE AND APPLIANCES Description Owned 1) Gold and Diamond Jewelry 2) House Furniture and Appliances

Present fair market value Rs xx lakhs Rs xx lakhs Yes Yes

INCOME FROM ALL SOURCES (Per month) A) Net Business Income B) Net income from Salary Rs xx lakhs per month Rs xx lakhs per month OATH OF AFFIANT I, Applicant Name hereby swear or affirm that the information set forth in this Affidavit of Personal Property, Income and Assets above is true, complete, and accurate.

_______________________ Signature of AFFIANT (Applicant) Sworn to and subscribed before me this __________ Day of __________________, ____________.

____________________ Notary Public